Laserfiche WebLink
RECEIVED BY SJCEHD (EF) ON 5/15/19 <br /> Please print or type.(Form designed for use on elite 12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number �[ <br /> WASTE MANIFEST CAL00041206D 408-353-3678 015893119 J J K <br /> 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) <br /> SALLY BEAUTY SUPPLIES 810229 <br /> 10710 TRINITY PKWY SC <br /> STOCKTON,CA 95219 <br /> Generalor's PhonaiC*477-SM <br /> 6.Transporter 1 Company Name U.S.EPA 10 Number <br /> ALL CLEAN HAZARDOUS WASTE REMOVAL INC. CAD982492399 <br /> 7.Transporter 2 Company Name U.S.EPA 10 Number <br /> TEMARRY RECYLING,INC. CARM01434217 <br /> 8.Designated Facility Name and Site Address RECICLADORA TEMARRY DE ME}IIC4 U.S.EPA ID Number <br /> A4}CGT30615001 <br /> CARRETERA FEDERAL NO.2 MEX <br /> SAN PABLO, TECATE BC <br /> Facility's Phone b1 W270-9M <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 16.Containers 1 f.Total 12.Unit <br /> HM and Packing Group(9 any)) No. Type Quantity Wt.N01, 13.Waste Cedes <br /> x 1. UN19507ASTEAERUS51-5(E=NO exceeding ap 31 D001 D035 <br /> o FLAMMABLE,N.O.S.,2.1 r'7 <br /> x 2. 331 D001 D035 <br /> tu <br /> ISOPROPANOL),3,PG II f] <br /> 4/ FgQ3 <br /> x 3. UN3267,WASTE CORROSNE LIQUID,BASIC,ORGANJC,N.O.S_, 331 D002 <br /> (CALCIUM HYDROXIDE.SODIUM HYDRO}4DE),8,PG II <br /> 4. N RCRA HAZARDOUS WASTE LIQUIDS,(DETERGENTS, r 1 561 <br /> GLYCOLS) � r <br /> 14.Special Handling Instructions and Addilional Information L� <br /> 1) RO1513 1 - � (Aeroso`]l�l_��a7r RIIrIARY EXP ER: TEMARRY RECYL ING INC PON 10541 <br /> 3) R E {(BaseH31ir ProdilC01Teme)6, R 15(3f[�'f06 (NRL-CP) to -pig) <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: 1 hereby declare that the mntents of this consignment are fully and accurately described above by the proper shipping name.and are dassihed,packaged, <br /> marked and labeled/placarded,and are in all respects it proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,i certify that the contents of this consignment conform to the terms of the attached EPA gmenf of Consent- <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quan *era or(b)(if I am a small quantity generator)is We. <br /> Generator R rJ e �,[7 E � 5 r Month Day Year <br /> =j 16. ritbinationN Shipments <br /> 1- 1:1 Import to U.S. Export from U.S. Pori of anhylexi[: Qmi�j 'MIC-S A L A - <br /> x Transporter signature(for exports only): h Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> Transp0der 1 Printed Typed TO V Signature MDnIJir Day year <br /> ❑ � 7 3 <br /> Ch- <br /> N <br /> Q Transporter 2 PnntedfTyped Name Signature Month Day Year <br /> ITIWAA/m/ 'F'reoge Tog e) I <br /> 18 Discrepancy r <br /> 18a.Discrepancy Indicabon Space ❑ quantic ❑T pe ❑Residue ❑Partial Rejection Quantity y fecti ED Full Rejection <br /> Manifest Reference Number <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> L) <br /> tdi Favirlty's Phone: <br /> LU 18c.Signature ofAltemate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,soder for hazardous waste treatment,disposal,and recycling systems) <br /> LU 11 2. 3. <br /> M)-�C'j 4. Jclb�Cl <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in item 182 <br /> Print ed Name Signature Mangy <br /> r� <br /> EPA Form 8700-22{Rev.3 0 Previous editions'21rotrsolgte. DESIGNATED ITY T ESTIMATION STATE (IF REQUIRED) <br /> �J <br />